Research: Weight-loss surgery promises cure for diabetes

| Tuesday, March 27, 2012

New research offers clear proof that weight-loss surgery can reverse and possibly cure diabetes, and doctors say the operation should be offered sooner to more people with the disease — not just as a last resort.

The two studies, released on Monday, are the first to compare stomach-reducing operations to medicines alone for "diabesity" — Type 2 diabetes brought on by obesity. Millions of Americans have the condition and can't make enough insulin or use what they do make to process sugar from food.

Both studies found that surgery helped far more patients achieve normal blood-sugar levels than did medicines alone.

The results were dramatic: Some people were able to stop taking insulin as soon as three days after their operations. Cholesterol and other heart risk factors improved greatly.

"We see it all the time," said Dr. Daniel Gagne, director of the West Penn Allegheny Bariatric Surgery Center, who said he performs about 300 gastric bypasses a year. "No one looks at all the numbers and sees what happens to these patients, but I don't think the results of the two studies are a surprise."

Locally, about a dozen doctors perform roughly 1,500 bariatric surgeries annually throughout the region, Gagne said.

Roughly 200,000 people in 10 counties in Western Pennsylvania, including Allegheny, Westmoreland and Washington counties, have Type 2 diabetes, according to the Centers for Disease Control and Prevention in Atlanta. There are more than a million people with Type 2 diabetes statewide, the CDC said.

Doctors don't like to say "cure" because they can't promise a disease will never come back. But in one study, most surgery patients were able to stop all diabetes drugs and their disease stayed in remission for at least two years. None of those treated with medicines alone experienced those results.

"It is a major advance," said Dr. John Buse of the University of North Carolina at Chapel Hill, a leading diabetes expert who had no role in the studies. "This evidence will help convince them that this really is an important therapy to at least consider."

Gagne said he has seen first-hand signs that the surgery itself — not just weight loss — helps reverse diabetes.

"Weight loss does play a part in it, but there's something else," he said.

Doctors believe that food makes the gut produce hormones to spur insulin, so trimming away part of it surgically may affect those hormones.

"The most proper name for the surgery would be diabetes surgery," said one study co-leader, Dr. Francesco Rubino, chief of diabetes surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center.

The studies were published online by the New England Journal of Medicine, and the larger one was presented yesterday at an American College of Cardiology conference in Chicago.

For a century, doctors have treated diabetes with pills and insulin, and encouraged weight loss and exercise with limited success.

Surgery offers hope for a long-term fix. It costs $15,000 to $25,000, and Medicare covers it for very obese people with diabetes. Gastric bypass is the most common type: Through "keyhole" surgery, doctors reduce the stomach to a small pouch and reconnect it to the small intestine.

An adult who has a body mass index — a calculation based on height and weight — of 30 or more is considered obese. That's 203 pounds or more for a 5-foot-9 man, for example.

The studies "are likely to have a major effect on future diabetes treatment," two diabetes experts from Australia, Dr. Paul Zimmet and George Alberti, wrote in an editorial in the medical journal. Surgery "should not be seen as a last resort" and should be considered earlier in treating obese people with diabetes, they wrote.

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